The loss of hand function will affect every aspect of an individuals life. This includes the ability to feed and care for themselves and the ability to work and participate in family life. For people recovering from problems such as trauma, burns or surgery affecting the hand, careful management of hand rehabilitation can influence the outcome for the patient significantly. In order to reduce the possibility of mobility difficulties occurring, including loss of joint range of motion, muscle and tendon sheath adhesions or non-functional scar tissue formation, continuous passive motion (CPM) is often indicated.
Additionally, for people with reduced mobility of the hand due to upper limb paralysis, such as those with cervical spinal cord injury, stroke, cerebral palsy or peripheral nerve injury, disregard for management of the maintenance of the joint range of motion of the effected hand will result in contracture and limited joint range of motion. Such syndromes will reduce hand function, which is already limited by paralysis, and will negatively affect potential outcomes for aggressive rehabilitation techniques, such as tendon transfer surgery and functional neuromuscular stimulation. Therefore, in such cases, CPM is also indicated.
Current devices applying CPM have shown to be effective in minimising the syndromes indicated above. Unfortunately, the use of such devices is not always prescribed by clinicians. This is due, mainly, to the limitations of these devices that are in the marketplace. These limitations include lack of secure finger placement, lack of portability, the inability to provide specialised therapy to specific joints, inflexible programming, of the device (only on or off with only one treatment modality) and, more importantly, the potential for damage to the hand to occur due to ineffective securing and placement of the fingers and thumb in the device.
It is important to note that the therapeutic benefits of continuous passive movement rely on the response of dense ordinary connective tissue to low-load prolonged stress (LLPS). In the human body, joints, tendons, ligaments, synovial membranes, fascia and the fibrous joint capsule are all composed of connective tissue. The deprivation of these elements of stress after an injury has been found to be detrimental. Indeed, profound structural and functional changes can occur which result in restricted mobility.
Although immobilisation had been previously championed with respect to the healing of orthopaedic injury (as early as the late nineteenth century by HO Thomas), such structural changes contraindicated it in many cases. These structural changes include:                Development of fibro-fatty deposits within the joint;        Diminished ground substance (which usually serves as a joint spacer and lubricant plus allows collagen fibres to glide freely);        Excessive randomly oriented collagen fibre crosslinks resulting in intrarticular and extraarticular adhesions;        A reduction in the extensibility of the joints with resultant joint stiffness.        
It has been shown that stress deprivation can cause what is termed iatrogenic immobilisation disease which is characterised by muscle disuse atrophy, disuse osteopenia and the destruction of articular cartilage with late secondary degenerative arthritis. In combatting the occurrence of such problems, CPM:                Maintains the proper constituents within the ground substance;        Inhibits abnormal cross-linking of collagen fibres;        Enhances cellularity, strength and mobility of the tissues.        
Thereby, CPM prevents intraarticular and periarticular adhesions. In achieving such a therapeutic benefit, CPM has shown to clinically:                Minimise joint stiffness;        Improve the healing and regeneration of articular cartilage;        Reduce inflammatory conditions;        Improve wound healing;        Improve the repair of Ligaments and tendons;        Reduce pain;        Support more rapid and stronger healing of repaired ligament;        Improve healing subsequent to bone fractures.        
In usual clinical hand therapy, therapists apply passive movement to the hand for mobilisation of its structures. CPM has been applied for the purpose of providing such therapy although with increasingly lasting results. Nevertheless, the limitations of prior art machines applying such CPM have reduced their impact on the patient population.
Prior art to embodiments of the invention is the portable continuous passive motion machine as applied to the human upper extremity. This has involved the attachment of a motor to the forearm. The motor usually drives a cross bar or longitudinal bars, which are attached to the fingers, in a cyclical pattern. These produce a continuous pattern of finger flexion followed by finger extension driven by the motor. This is for the purpose of maintaining and improving the condition of the hand during rehabilitation. This includes improving finger joint range of motion, reduction of oedema and reducing the likelihood of tendon sheath adhesions.
Prior art weighs the hand down with a motor which, in addition to being heavy and awkward for the user (thus limiting their mobility), is non-cosmetic. Additionally, the 15 power requirements of the motor limit the portability, especially if the device is driven from mains power. Where the device is battery driven, the length of therapy is limited. The cross bar configuration of the prior art allows the possibility of misalignment of the fingers in the device, thereby producing the risk of damage to the hand. Such therapy is applied to all the fingers at the same time, in the same manner. Therefore, tailoring of therapy to individual fingers and joints is not possible.
Priority needs are repeatability, reliability and portability. Preferred devices should also be cosmetically pleasing, light weight, energy efficient for portable battery power, flexible in operation and comfortable, robust, easy to don and doff securely, and safe when used.